1. Improving Your Referral Inquiry to Admission Rate
Growing your census with out making the phone any more than it already is!
Kurt Kazanowski MS RN CHE

2. What You Will Learn In This Session
How to grow your census and revenue without spending another dollar on marketing.
Why the term NTUC (Not Taken Under Care) is a “dirty-word.”
The essential structures and processes needed to build a high performing Intake and admission engine.
The Art and Science to building and working a pending list.

3. Why brother? Is it Worth it?
Real-life example:
This is a 65 ADC hospice receiving about 50 referrals a month (or 300 for six months), LOS of 65 and a conversion rate of 66%. The Gold Standard is an 85% conversion rate. The per diem rate for this hospice is $150. This example does not include any GIP. Being able to move the conversion needle by just 1, 2, 3, 4 or 5 percent will yield the following…

4. Yields…
1% = 3 more patients served. Generating 195 DOC (days of care) x $150 = $29,350
2% = 6 more patients served. Generating 390 DOC x $150 = $58,500
3% = 9 more patients served. Generating 585 DOC x $150 = $87,750
4% = 12 more patients served. Generating 780 DOC x $150 = $117,000
5% = 15 more patients served. Generating 975 DOC x $150 = $ 146,250
If this organization was able to achieve the Gold Standard of 85% (a 19% improvement) it would generate $555,750
All this without making the phone ring any more than it already is!

5. It Starts With a Referral Inquiry
Does your organization have a standard operating definition and procedure for a referral inquiry?
Referral Inquiry = ANY incoming request
Professional
Consumer
Internet or web
Napkin
Walk-in
Name, location--> go!

6. The ONLY 4 Reasons a Referral is NTUC
The referral died before we could get to them.
The referral lives outside the service area.
The referral has no payor source and administratively a decision is made not to pursue.
The referral source threatens physical violence if we contact him/her again.
Every other referral that does not convert to an admission with in 24-hours in place on the 90-day pending list.

7. 2011 – Jan NTUCs
Total 4,201
Pt/Family refused hospice
1,336
Patient died
1,121
Chose another hospice
916
Undefined reason
216
Not hospice appropriate - medically
204
Duplicate referral 79
Moved out of coverage area 65
Referred to another hospice 55
Admitted to Skilled Part A 44
Physician refused 43
Admit to non-contracted facility 37
Pt/Family refused palliative 36
Out of network with insurance 35
Referred to Palliative Care 19
Service failure 3

8. The Pending List “Gold in the Hills”
The larger the pending list the better!
Work a 90-day process to eliminate the barrier(s) preventing the patient/family from electing their hospice benefit.
“Working the pendings”

9. Organizing Your Pending List
All pending referrals stay on the pending list for 90-days.
The pendings are categized into the following “buckets”
Patient/Family Issues.
Physician Issues.
Not Eligible.
Aggressive Treatment.
On Skilled Days.
Contracting Issues.
On Another Hospice
Identify what the barrier(s) to admission are.

10. Working The Pending List
Each pending has a note indenting a specific barrier.
Commitment to Conversion & Collective Wisdom
Daily stand-up meetings
Leadership attendance & support
Brainstorming creative solutions
Measure and analyze. Complete a 90-day rolling conversion report monthly.

11. Start a Change Process 4 areas of Focus Infrastructure
Staffing & Scheduling; Orientation; Reports management
Referral Inquiry
New Process/Pendings Management
Sign on
Standardize training; Informed consent; Insurance/finance assessment; EOL goal conversation
Admission
Documentation reduction; Skilled time management

12. All Hands on Deck + ED, CD, DBD, TD, HCC’s Admission Coordinators
Customer service & Scheduling a visit
Coordinating pending follow-up
End of day “sweep”
Entering ALL referral inquiries
Documentation: Pending Referral Profile
Who / What / When?
+ ED, CD, DBD, TD, HCC’s
Collective wisdom
Stand up meeting
Brainstorming solutions
Engaging resources from ENTIRE organization

13. 90- Days Commitment to Conversion
Identifying & overcoming barriers
Daily “stand up”
Collective wisdom
“All hands on deck”

14. Measuring Success: A 90-Day Rolling Conversion Rate.
The goal is to achieve an 85% rolling conversion rate.
Example: To calculate April’s 90-day rolling conversion rate:
Total the number of referrals and admissions for February, March and April.
February March April TOTAL
41/ / / referrals and 80 admission. 64%
To calculate May’s 90-day rolling conversion rate. Drop off February and add May:
March April May TOTAL
39/ / / referrals and 88 admissions. 69%

15. Key Take-a-ways
Widen the top of the referral funnel and make sure to capture and record all referral inquiries; even those “napkin” referrals.
Become very clear about the criteria making a referral Not Taken Under Care, and thus taken off the radar screen!
Create and organize a pending list that will allow you to work 90- days to convert a referral to an admission.
During your morning stand-up meetings, review those pending referrals that are a few days new. On weekly basis with your clinical leadership, marketing staff and Referral Intake Coordinator (use the collective wisdom of the group), scrub all the pending referrals and update their status.

16. Continued
Training and education on how to be innovative thinkers, and to break through barriers that are preventing pending referrals from converting to an admission. Truly thinking outside the box can move the conversion needle.
Measure, measure and measure using a 90-day rolling conversion rate.

17. Resources
conversion-rate/#more-271
admission/#more-503

18. Contact Information
Kurt A. Kazanowski, MS. RN, CHE
296 S. Main Street, #203
Plymouth, Michigan 48170